4
Treatment of Localized Gastric Cancer 1.Surgical therapy is the only means of cure and is the treatment of choice for early stage disease. 2.Endoscopic mucosal resection (EMR) is reserved for T1a disease. 3.Goal is complete resection with negative margins (R0). 4.Emerging role of laparoscopic resection for gastric and esophageal cancer. 5.Proximal cancer: total gastrectomy vs. esophagogastrectomy.

8
Importance of Preoperative Staging When Considering Neoadjuvant Therapy Accuracy of predicting nodal involvement is 60-80% Surgery alone may be sufficient for Stage II disease Neoadjuvant therapy may be overtreating some patients

9
Rationale for Up Front Surgery in Patients With Gastric Cancer Pathologic staging may result in more appropriate choice of adjuvant therapy (accurate stage II vs III, D1 vs D2, margins). Symptomatic patients may require initial surgery. In reality, gastrectomy is often performed before MDT consultation.

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Summary Adjuvant Therapy for Proximal Gastric Cancer 1.While preoperative therapy may be preferred in most cases, initial gastrectomy is being commonly performed. 2.While R0 gastrectomy with D2 lymphadenectomy is recommended, less radical surgery is common. 3.Chemoradiation appears to have a role in reducing local recurrence. 4.Postoperative chemoradiation should be considered when managing a post-op patient, particularly when
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